[Pulmonary and pleural manifestations of multiple myeloma]

Multiple myeloma is a low malignant, non-Hodgkin's lymphoma, which is characterised by infiltration of the bone marrow by clonal prolifaration of atypical plasma cells. Clinical presentation is mostly determined by the sequeles of displacement of normal hemopoiesis, destruction of bones and the immune deficiency. Extramedullary manifestations are relatively rare. Pulmonary and pleural involvement has been described in case reports only. We report on a 75-year-old male patient in whom an IgG-secreting multiple myeloma type lambda, stage III (according to Durie and Salmon) has been diagnosed. Chest X-ray and CT revealed a diffuse confluent nodular pattern in the lungs and a large left-sided pleural effusion. Histology and immunohistochemistry confirmed diffuse infiltration of the lungs as well as the pleura by dysmature plasma cells with deposition of lambda-light chains. Preliminary treatment with vincristine and prednisone followed by polychemotherapy according to the VAD scheme was performed, which led to resolution of the pleuropulmonary changes.

Seltene Ursache einer diffusen alveolären Hämorrhagie bei einem 45-Jährigen

Diffuse pulmonary hemorrhage denotes a diffuse bleeding into the alveoli as a result of severe damage of the alveolocapillary membrane. Autoimmune diseases, toxic injury and hemodynamic changes are the most frequent causes. A 45 year old male patient presented with diffuse alveolar hemorrhage. An Immunoglobulin A (IgA) paraprotein secreting myeloma was found to be the underlying cause. Immunohistochemistry revealed dense pericapillary and perivascular deposits of IgA, indicating a paraprotein mediated damage of the alveolocapillary membrane. The predominantly vascular pattern of damage was regarded as the most likely cause of the pulmonary hypertension in this patient. The diffuse pulmonary bleeding stopped after initiation of treatment consisting of vincristine, adriamycine and dexamethasone.

[Differential diagnosis of diffuse pulmonary haemorrhage]

Diffuse alveolar haemorrhage (DAH) denotes a diffuse intra-alveolar bleeding from small vessels as a result of severe damage of the alveolocapillary membrane of the lungs. These are comparatively rare, but than often life threatening events. The differential diagnosis is broad and comprises immunologic as well as toxic, infectious, hemodynamic, neoplastic and physical causes. DAH may be a manifestation of systemic diseases, as well as a result of an injury restricted to the lungs. The most frequent systemic diseases, that cause DAH are the so-called small vessel vasculititis-microscopic polyangiitis and Wegener's granulomatosis. More rarely Goodpasture's syndrome and systemic lupus erythematosus are causal. Alongside the immunologic processes mainly diseases with increased left-ventricular preload, infections and side effects of drugs have to be kept in mind. This review summarizes the differential diagnostic spectrum and the diagnostic workup of patients with DAH. Because early aggressive treatment can be life-saving, early and aimed diagnostics is essential.

Analytical model for ion acceleration by high-intensity laser pulses

We present a general expression for the maximum ion energy observed in experiments with thin foils irradiated by high-intensity laser pulses. The analytical model is based on a radially confined surface charge set up by laser accelerated electrons on the target rear side. The only input parameters are the properties of the laser pulse and the target thickness. The predicted maximum ion energy and the optimal laser pulse duration are supported by dedicated experiments for a broad range of different ions.

Collimated multi-MeV ion beams from high-intensity laser interactions with underdense plasma

A beam of multi-MeV helium ions has been observed from the interaction of a short-pulse high-intensity laser pulse with underdense helium plasma. The ion beam was found to have a maximum energy for He2+ of (40(+3)(-8)) MeV and was directional along the laser propagation path, with the highest energy ions being collimated to a cone of less than 10 degrees. 2D particle-in-cell simulations show that the ions are accelerated by a sheath electric field that is produced at the back of the gas target. This electric field is generated by transfer of laser energy to a hot electron beam, which exits the target generating large space-charge fields normal to its boundary.

Transverse characteristics of short-pulse laser-produced ion beams: a study of the acceleration dynamics

We report on first measurements of the transverse characteristics of laser-produced energetic ion beams in direct comparison to results for laser accelerated proton beams. The experiments show the same low emittance for ion beams as already found for protons. Additionally, we demonstrate that the divergence is influenced by the charge over mass ratio of the accelerated species. From these observations we deduced scaling laws for the divergence of ions as well as the temporal evolution of the ion source size.

Laser acceleration of quasi-monoenergetic MeV ion beams

Acceleration of particles by intense laser-plasma interactions represents a rapidly evolving field of interest, as highlighted by the recent demonstration of laser-driven relativistic beams of monoenergetic electrons. Ultrahigh-intensity lasers can produce accelerating fields of 10 TV m(-1) (1 TV = 10(12) V), surpassing those in conventional accelerators by six orders of magnitude. Laser-driven ions with energies of several MeV per nucleon have also been produced. Such ion beams exhibit unprecedented characteristics--short pulse lengths, high currents and low transverse emittance--but their exponential energy spectra have almost 100% energy spread. This large energy spread, which is a consequence of the experimental conditions used to date, remains the biggest impediment to the wider use of this technology. Here we report the production of quasi-monoenergetic laser-driven C5+ ions with a vastly reduced energy spread of 17%. The ions have a mean energy of 3 MeV per nucleon (full-width at half-maximum approximately 0.5 MeV per nucleon) and a longitudinal emittance of less than 2 x 10(-6) eV s for pulse durations shorter than 1 ps. Such laser-driven, high-current, quasi-monoenergetic ion sources may enable significant advances in the development of compact MeV ion accelerators, new diagnostics, medical physics, inertial confinement fusion and fast ignition.

[Primary pulmonary rhabdomyosarcoma as a rare differential diagnosis of small cell lung cancer]

Primary pulmonary rhabdomyosarcoma is a rare entity and the histological differential diagnosis can be difficult. We report on a 43-year old female patient, smoker (25 pack-years), in whom a large solitary brain metastasis was diagnosed and enucleated. Histological examination revealed a typical small cell carcinoma and histological examination of biopsies obtained from a tumor in the left upper lobe of the lung was compatible with a small cell carcinoma. Despite chemotherapy there was a progressive tumor growth. Bronchial biopsies again showed a small cell tumor, although immunohistochemistry proved it to be a pleomorphic rhabdomyosarcoma. Due to the progressive tumor growth with necrosis and superinfection and a lack of further metastases lobectomy of the left upper lobe was performed, complicated by postoperative pleural empyema, limiting the possibilities of adjuvant therapy. Early relapse occurred with pleural, pulmonary, chest wall and spinal metastases. Laminectomy and extirpation of the spinal metastases, local radiotherapy and chemotherapy with iphosphamide and doxorubicine led to partial remission and clinical improvement for few months only. The patient died from metastatic primary rhabdomyosarcoma of the lung. This rare tumor mimicked small cell lung cancer. Appraisal of the atypical clinical course and a close dialogue between pathologists and clinicians enabled the correct diagnosis.

Comparison of laser ion acceleration from the front and rear surfaces of thin foils

The comparative efficiency and beam characteristics of high-energy ions generated by high-intensity short-pulse lasers (approximately 1-6 x 10(19) W/cm2) from both the front and rear surfaces of thin metal foils have been measured under identical conditions. Using direct beam measurements and nuclear activation techniques, we find that rear-surface acceleration produces higher energy particles with smaller divergence and a higher efficiency than front-surface acceleration. Our observations are well reproduced by realistic particle-in-cell simulations, and we predict optimal criteria for future applications.

Influence of the laser prepulse on proton acceleration in thin-foil experiments

We investigate the influence of the laser prepulse due to amplified spontaneous emission on the acceleration of protons in thin-foil experiments. We show that changing the prepulse duration has a profound effect on the maximum proton energy. We find an optimal value for the target thickness, which strongly depends on the prepulse duration. At this optimal thickness, the rear side acceleration process leads to the highest proton energies, while this mechanism is rendered ineffective for thinner targets due to a prepulse-induced plasma formation at the rear side. In this case, the protons are primarily accelerated by the front side mechanism leading to lower cutoff energies.